부산대학교 도서관

The interaction of the heart and arterial system (ventricular - arterial coupling) is a key determinant of cardiovascular performance. Vascular elastance (Ea) and LV end-systolic ventricular elastance (Ees) are increasing simultaneously during aging and heart failure (HF). Beta blockers (BB) are recommended therapy for patients with HF, but impact of BB on ventricular and arterial elastance remains unclear.The aims of our study were: 1) to compare Ea and Ees in elderly patients with HF before and after BB, and 2) to estimate relationship between arterial elasticity and exercise capacity.Methods: Elderly patients with HF (n = 610 age ≥ 65 years, NYHA ≥ II), who were treated with BB according to CIBIS-ELD protocol of uptitration, underwent echo-Doppler characterisation of Ea, Es and ventricular-aterial couplung (Ea/Es). Left ventricular systolic and diastolic function were also obtained before and after 12 weeks of BB. Exercise capacity was estimated by cardiopulmonary bicycle submaximal testing in 30 consecutive patients (Cibis subgroup). Participants in the Cibis subgroup were an integral part of large CIBIS-ELD cohort study patients.Results: During 12 weeks of BB, arterial elasticity has been improved (Ea, from 2.59 to 2.39, p = 0.014) in patients from CIBIS-ELD group. Overall Ees and Ea strongly correlated before (r = 0.484) and after BB (r = 0.558) with similar relationship (p < 0.001), indicated preserved ventricular arterial coupling in whole group. Left ventricular ejection fraction after BB improved (p= 0.003) and symptoms of breathlessness reduced (p = 0.001). Estimated end-diastolic LV pressure, measured by Doppler ratio (E/e), closely related to Ea (p = 0.031). There were strong correlations between Ea and peak oxygen uptake (p = 0.004) and oxygen pulse (p = 0.001) in 30 patients from the CIBIS subgroupConclusions: Ventriculo-arterial coupling, especially Ea, can be a useful marker of therapeutic goals of BB on diastolic LV function and exercise capacity.